Dan Nicolae Paduraru

Dan Nicolae Paduraru

Defensive Surgery - a New Under-Recognized Reality among Surgeons

In recent years, the number of medical litigations is increasing and defensive medicine becomes a widespread approach among physicians all over the world. Defensive behavior of physicians is more common in scheduled, elective, compared to emergency medical services. The immediate direct consequences of this defensive behavior are found in the increase of costs (additional investigations) and the increase of waiting time for certain procedures and interventions (repeated postponements). Difficult and uncomfortable to admit that it exists, but defensive behavior is a reality. It raises numerous and complex ethical issues, and the goal of health policies should be to reduce this phenomenon.

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Features of Acute Pancreatitis Patients Admitted to a General Surgery Clinic

Acute pancreatitis is an important current problem with a growing frequency and a potentially severe or even fatal evolution in some cases. In recent years, an increase in the incidence of acute pancreatitis has been observed in the population, which emphasizes the importance of establishing optimal therapeutic behavior. We performed a descriptive, retrospective clinical study, from January 2015 to November 2018, single-center, on a number of 57 patients with the diagnosis of acute pancreatitis. The presentation characteristics of patients with acute pancreatitis are largely consistent with the literature, with patient sex being the sure parameter that highlights a significant difference, with a greater number of women being diagnosed with acute pancreatitis.

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Surgical Alloplastic Approach with Dual Mesh in a Multisacular, Recurrent Incisional Hernia – Case Presentation

Repairing an incisional ventral hernia represents a challenge for the surgeon. The high recurrence rates observed during hernia repair by tissue approximation leads to development of tension-free procedures by using prosthetic materials. Incisional or ventral hernia is a very common multifactorial pathology that requires surgical intervention to prevent complications, such as pain, discomfort, bowel obstruction or strangulation. To perform the wall repair it is of utmost importance to understand the pathogenesis of the hernia, the anatomy and physiology of the abdominal wall, and surgical techniques. Several repair methods are available, including open suture repair, open mesh repair, the component separation technique, and tissue expansion assisted closure. To perform the ventral hernia repair properly, a full understanding and correct selection of mesh and management of probable complications, such as seroma, bowel injury, enteric fistulae, and recurrence, is essential. There are lots of scientific debates about an ideal material for mesh parietal repair. In latest years, the tendency is that the continuous decreasing territory of polyester mesh to be slowly replaced by the increasing territory of polypropylene mesh in open procedures for abdominal incisional hernia repair. The goals of incisional hernia repair are the prevention of visceral eventration, incorporation of the abdominal wall in the repair, provision of dynamic muscular support, and restoration of abdominal wall continuity in a tension-free manner. We present the case of a 55 years old woman who had a history of multiple surgical interventions. We performed an open surgical approach, tension free technique using an intraperitoneal dual-mesh.

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Inflammatory Bowel Diseases: the Surgical Perspective

Inflammatory bowel diseases (IBD), namely Crohn’s disease and ulcerative colitis, are relatively rare diseases in our country, known as a low prevalence geographic region. IBD are a multidisciplinary problem, that implies gastroenterologists, as well as surgeons. Surgical management in inflammatory bowel disease is often impaired by a high complication rate and a significant recurrence rate, specifi c mostly for Crohn’s disease. Indications for surgery include failure of medical therapy (including delayed puberty for young patients and drug intolerance), toxic megacolon, bowel perforation, obstruction, enteric fi stula and abdominal or perianal abscess. Advances in medical treatment options for IBD are continuously accumulating. However, a large number of patients still require surgical procedures during lifetime.

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Hypercholesterolemia, as a Predictor Factor of Severe Acute Pancreatitis

Dyslipidemia constitutes a well-known factor that can lead to acute pancreatitis. Hypertrigliceridemia and hypercholesterolemia are part of dyslipidemia. In a prospecitve study, we analyzed the role of hypercholesterolemia in triggering episodes of acute pancreatitis and the capacity of cholesterol blood level to predict the severity and the evolution of acute pancreatitis. In our prospective study, a preexistent cholesterol blood level above 240 mg/dl proved to be a trigger for pancreatitis and an increasing cholesterol level in evolution predicts a pancreatitis with organ failure (moderately-severe or severe).

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